How Stem Cell Therapy help for Rheumatoid Arthritis

Stem cells help regulate the immunological system of the body. They can increase regulatory adaptive T cells and decrease inflammatory cells in the peripheral blood, spleen, lymph nodes and in the joints. Also, stem cells work by decreasing proinflammatory cytokines like interferon γ, tumor necrosis factor α, IL-4 and IL-17.

Research has shown ability of mesenchymal stem cells to migrate into inflamed and damaged tissues. This way stem cells are focused in regeneration of injured tissue and organs. They possess the ability to differentiated to other cell types, including chondrocytes, osteoblasts and myocytes cartilage. In conclusion, mesenchymal stem cells help delay the arthritis inflammation with a constant modulation of the activity.

The disease of rheumatoid arthritis (RA) is a chronic inflammation in the joints, that affects 1-2% of the global population. Is also known as a primary cause of disability worldwide since it produces inflammation and progressive joint destruction. It is caused by an abnormal cellular signal pathway caused by the joint action environmental, genetic, and autoimmune factors.

Stem cell therapy for rheumatoid arthritis (RA) patients helps regenerate the damaged tissue in the joints, reduce the inflammation and reduce the progression of the disease.

Stem cell therapy for rheumatoid arthritis

Huang et al in 2019 conducted a study of 64 Rheumatoid arthritis patients. They obtained results showing stem cell therapy as a safe procedure in all the patients, without any evidence of abnormalities in a rutinary blood examinations.

Another conducted study was done in patients with history of refractory RA. Autologous stem cells intravenously administrated showed benefits after a review within one, six and twelve months later. Suggesting an impressive effect of mesenchymal stem cells on humoral responses of the body.

Several conducted investigations studied the role of exosomes released by mesenchymal stem cells. When obtained from bone marrow, osteogenic and adipogenic differentiation is present. Results found that the exosomes released from the stem cells are more effective in suppressing inflammation. This investigation supports therapeutic role of the bone marrow stem cells exosomes as inhibitors of inflammation and to mitigate RA symptoms.

Stem cells are a special type of cell that has not yet dedicated itself toward a particular type of tissue. Most cells in the body are specific and local to a certain body part. For example, skin cells always make new skin cells, and brain cells are always brain cells. Stem cells are not limited in this way. Instead, these new cells will take on the form of the tissue that surrounds them.

Because of this property, stem cells can be effectively used to attempt to aid in the repair and regeneration of damaged tissues. This is at the heart of stem cell therapy and is why these treatments could be effective for patients suffering from rheumatoid arthritis. By giving worn-down tissue the proper tools to repair itself, the body can regenerate naturally.

How does the stem cell therapy procedure for rheumatoid arthritis work?

Initially, every patient requires a complete medical evaluation to determine whether you are a candidate for the procedure or not.

If candidate for the therapy, a specific program according to patient’s health status is recommended. The obtention of stem cells is through a bone marrow extraction and intravenous administration. Everything is done ambulatory, with a duration of 1 or 2 hours.

The next days and months, we continue a follow up regarding medical status of the patient and results obtained after the procedure.

Therapy with stem cells can be repeated after 4 to 6 months, according to clinical and medical evaluation.

Before the therapy begins, a doctor will evaluate your medical records and general health. A thorough physical examination will be completed to assess your overall health and record your vital signs. The doctor will also be available to answer any specific questions you may have about the treatment before it begins.

After your preliminary examination, the procedure can begin. The doctor will begin by disinfecting the area from which bone marrow will be harvested. The area will then be locally anesthetized and extraction will begin. The extraction itself will take between 15 and 20 minutes, and you will not feel any pain during the procedure.

The amount of bone marrow that must be harvested will depend on the target cell count of the serum and how many injections are needed to treat all affected areas. Once the bone marrow has been extracted, the doctor will activate the stem cells in a closed system to prevent outside contamination. This bone marrow infusion creates a serum that can them be re-injected into the patient’s body to treat an affected joint.

The stem cell serum should be injected as close as possible to the affected area so that the stem cells can get to work rebuilding damaged tissues. The results will not be instantaneous, but you will begin to see signs of improvement once the cells have begun to grow and repair tissue.

What are the most suitable cell types for therapy?

Bone marrow stem cells are the first option for treating rheumatoid arthritis. When the patient is not a candidate due to the health status, then a second option for stem cells therapy is using umbilical cord stem cells.

Are there side effects?

When the extraction of stem cells is from the bone marrow, patients refer soreness in the area of the extraction. It is expected to be present due to the minimal invasive procedure. But this discomfort diminishes after a few days and does not cause any problem with daily activities.

Success rate of stem cell therapy for Rheumatoid Arthritis

Every patient responds differently to the treatment. Most of our patients show beneficial results in different medical and clinical areas. Patients mention improvement of symptoms, with an enhancement of their quality of life. Even shows improvement at blood work and imaging studies done after stem cell therapy.

The problem with traditional treatments for RA

Despite numerous anti-rheumatic drugs, a significant number of patients with rheumatoid arthritis does not respond or are intolerant to current treatments. Still with a constant follow up of doctor’s indications, the improvement of the symptoms is not present. Rheumatoid arthritis still has a high disease recurrence rate and side effects after long-term use of traditional medicines for this disease.

Differently from the traditional treatments for RA, stem cell therapy for rheumatoid arthritis has very minimum side effects to the procedure. Stem cells are the only therapy, in present, with possibility of regeneration of injured tissue caused by the inflammation. Also, stem cells provide unique capacity of modulating the immunological system in a long lasting effect.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune condition characterized by inflammation in the joints. Unlike other forms of arthritis, which usually develop due to age or injury, rheumatoid arthritis can develop in patients of any age. Its presence often coincides with psoriasis, a skin condition characterized by brittle, flaky skin and frequent scabbing. The link between psoriasis and arthritis is not yet fully understood, but scientists believe that cytokines, a protein responsible for cell signaling, may play a role.

Is a chronic autoimmune inflammatory disease. The main injury is located at the joints, primarily in the skeletal joints. Through time these can lead to a loss of cartilage and bone loss, followed by deformation and lack of function of the joints. The most often joints affected are hands in proximal interphalangeal joints, and metacarpophalangeal joints, wrists, feet, and knee may be involved. All mentioned previously, leads to disability. Reason why early diagnosis is key to optimal therapeutic success.

Symptoms of rheumatoid arthritis

Rheumatoid arthritis symptoms vary somewhat between patients, but many symptoms are commonly shared. Pain and swelling in the joints is common, with severity varying from fairly mild to totally debilitating. Additionally, many patients experience flu-like symptoms, including fatigue, loss of appetite, cold extremities, fever and general weakness. For some patients, symptoms are worse after prolonged periods of sitting. Others experience occasional or frequent flare-ups where symptoms are worse than normal; the disease may go into periods of remission from time to time.

As a progressive disease, rheumatoid arthritis symptoms will tend to worsen with time. In its earliest stages, rheumatoid arthritis will cause swelling of the synovial fluid and lining of the joint. Over time, the synovium will thicken due to the rapid division of cells in the area. These inflamed cells then release enzymes that may break down the bone and cartilage of the joint.
As the joint is worn down by this enzymatic reaction, the bones will begin to lose their strength and shape. This creates a loss of flexibility in the joint and is accompanied by substantial pain. Over time, severe rheumatoid arthritis will lead to permanent joint damage, including bone deformity and irregular growths. These complications can make rheumatoid arthritis a crippling disease. Fortunately, some patients may find relief through stem cell therapy.

• Pain in multiple joints
• Stiffness in multiple joints, especially after sitting or resting for longer periods of time
• Morning stiffness lasting more than one hour
• Swelling
• Systemic symptoms when active disease:
  • Fatigue
  • Weight loss
  • Low-grade fever

Rheumatoid Arthritis Stages

• Stage One: Early stage, notable presence of synovial membrane inflammation. There is joint swelling and pain on motion.
• Stage Two: Moderate stage, Synovial tissue starts to grow into the joint cavity, across the cartilage.
• Stage Three: Accumulation of synovial fluid polymorphonuclear leukocytes, as well as synovial cell proliferation.
• Stage Four: End-stage, cessation of inflammatory processes, formation of fibrous tissue, in some patient even fusing of the bone, meaning of ceased joint function.

 

What to expect at your stem cell therapy appointment?

A medical and physical evaluation. If you assist with previous studies, they will be examined to complement the evaluation and conclude whether you’re a candidate for the procedure or not. Also, we answer any question you may have about stem cells therapy and beneficial effects in rheumatoid arthritis patients.

Does the procedure hurt?

With most patients there is no referred pain during the procedure. Some patients with bone marrow stem cell therapy refers as a mild to moderate discomfort when the extraction is initiated and diminishes seconds to minutes later.

From what moment are the results seen?

Stem cell start working from the moment they are administrated. But an improvement of the symptoms in patients are evident months after the procedure is done. Benefits continue for a long period of time, even longer when patients complement therapy with healthy lifestyle and a close follow up of doctor’s indications.

Who are candidates?

Patients with autoimmune, neurological, metabolic diseases, ophthalmological affections, and orthopedic diseases like osteoarthritis. Also, patients who are looking for an improvement of quality of life complementing their healthy lifestyle.

How and why can there be a rejection of the administered cells?

There is NO rejection of stem cell therapy when using autologous stem cells. These cells are obtained from the bone marrow of the same patient and are used moments after the extraction. On the contrary, when patients go through a therapy with umbilical cord stem cells the risk of rejection is present due to the identification as external cells from the body.

 Fuentes:

• Lopez M, Bueren J, Garin M, Mesenchymal stem/stromal cell-based therapy for the treatment of rheumatoud arthritis: An update on preclinical studies, EbioMedicine (2021)
• (1) Gowhari A, Shariati Z, Tavakkol J, Ghasemi A, Ghoryani M and Mohammadi M, A significant decrease of BAFF, APRIL, and BAFF receptors following mesenchymal stem cell transplantation in patients with refractory rheumatoid arthritis, research paper, Gene, (2020); Vol. 732.
• (2) Huang Y, Lu D, Ma W, Liu J, Ning Q, Tang F, Li L, miR-223 in exosomes from bone marrow mesenchymal stem cells ameliorates rheumatoid arthritis via downregulation of NLRP3 expression in macrophages, Molecular Immunology 143 (2022) 68-76